- Email: [email protected]
Palliative treatment in tricuspid atresia
INTERNATIONAL
ABSTRACTS OF PEDIATRIC SURGERY
exception every child had been in cardiac failure requiring hospitalization and continual digitalis and diuretic therapy. Most patients suffered from an advanced disease and were regarded as salvage cases at the time of surgery. In the 21 patients with mitral disease, there were 8 postoperative deaths and 2 late deaths. In the 4 patients with aortic disease, there were 2 deaths. Starr-Edwards ball valves were used ex.. clusively. Survival has been 48 per cent, which approximates that previously reported in other series. The authors believe a better survival rate can be obtained by performing the operation earlier in the course of the disease before the patients become salvage cases--D. T. Cloud.
719
has a significant though small failure rate and since the surgeon is there anyway, a HanlonBlalock procedure is preferable to balloon septostomy.-J. G. Rosenkrantz. THE RESULTS OF TRANSPOSINGTHE ATRIAL SEPTUM (EDWARDS PROCEDURE) IN PATIENTS WITH TRANSPOSITIONOF THE GREAT VESSELS. F. I. Ehrenstein, J. L. Attkeney, J. Liebman and L. H. Coffin. Ann. Thorac. Surg. 8:66-72
(July)
1969.
Twenty patients with transposition underwent Edwards’ modification of the Blalock-Hanlon procedure. Six of these had had intact ventricular septa and of these 3 died postoperatively with bilateral pulmonary hemorrhage and one with thrombosis of the right pulmonary veins. One AORTIC VALVULAR ARTRESIA AND PREMATURE survivor, with an additional large atria1 septal CLOSURE OF THE FORAMEN OVALE. C. R. defect, is doing well and the other two survivors Peterson, D. N. Bramwit, D. E. Craig and R. C. showed progressive cyanosis, culminating in death Jones. J. Thorac. Cardiov. Surg. 58:79-83 during re-operation for ASD creation in one pa(July) 1969. tient and in successful complete correction in the This is a report of the clinical and postmortem second. Fourteen of these patients had coexisting venfindings in a newborn with aortic atresia, hypotricular septal defects with 2 operative deaths. plasia of the left ventricle and closure of the The other 12 showed prolonged improvement in foramen ovale. The angiographic appearance of cyanosis and cardiac failure, although one dethis entity is similar to that of truncus arteriosus, teriorated 2 years later and died during total and the authors point out means of differentiating correction, and another, with mild persistent failbetween the two. The anomaly described in this ure also failed to survive later correction. Only paper is not presently operable, but lesser degrees of abnormality are-hence the importance of disone of these patients had had pulmonary arterial tinguishing it from truncus arteriosus.-J. G. banding and subsequently showed increasing cyaRosenkrantz. nosis. Four other patients banded themselves postoperatively, with the development of signifioutflow obstruction after the PALLIATIVETREATMENT IN TRICUSPID ATRESIA. cant left ventricular atrioseptoplasty. W. Rashkind, 1. Waldhausen, W. Miller and Others have reported similar findings and the S. Friedman. J. Thorac. Cardiov. Surg. 57:812consensus at the present time seems to be that 818 (June) 1969. Edwards’ modification of the Blalock-Hanlon proThe authors describe 8 infants with tricuspid cedure should not be used in the patient with atresia or stenosis and large a-waves in the right transposition and on intact ventricular septum. In atrium who underwent balloon atrioseptostomy the patient with transposition and ventricular and immediate operative creation of an aorticseptal defect, whether it is preferable to creation right pulmonary arterial anastomosis (7 patients) of an atria1 septal defect and pulmonary arterial or pulmonary artery banding (1 patient). Two banding remains to be seen.--l. G. Rosenkrantz. infants died after the shunt procedure, one on the first postoperative day with diffuse pulmonary VENTRICULAR SEPTAL DEFECT AND AORTIC emphysema and one on the sixth postoperative REGURGITATION. K. A. Hallidie-Smith, E. G. 1. day with intestinal obstruction and peritonitis. Olsen, C. M. Oakley, J. F. Goodwin and W. P. When, in a patient with tricuspid atresia, there Cleland. Thorax 24:257-259 (May) 1969. is evidence of increased right atria1 pressure and either increased or decreased pulmonary flow, the Twenty-seven of 29 patients with associated authors recommend immediate attack on both ventricular septal defect and aortic regurgitation interatrial obstruction (by balloon septostomy) were operated upon at the Cardiothoracic Surgical and abnormal pulmonary flow (by surgery). One Unit of the Royal Postgraduate Medical School might well argue that, since balloon septostomy in London, England. The most common cause of
ABSTRACTS OF PEDIATRIC SURGERY
exception every child had been in cardiac failure requiring hospitalization and continual digitalis and diuretic therapy. Most patients suffered from an advanced disease and were regarded as salvage cases at the time of surgery. In the 21 patients with mitral disease, there were 8 postoperative deaths and 2 late deaths. In the 4 patients with aortic disease, there were 2 deaths. Starr-Edwards ball valves were used ex.. clusively. Survival has been 48 per cent, which approximates that previously reported in other series. The authors believe a better survival rate can be obtained by performing the operation earlier in the course of the disease before the patients become salvage cases--D. T. Cloud.
719
has a significant though small failure rate and since the surgeon is there anyway, a HanlonBlalock procedure is preferable to balloon septostomy.-J. G. Rosenkrantz. THE RESULTS OF TRANSPOSINGTHE ATRIAL SEPTUM (EDWARDS PROCEDURE) IN PATIENTS WITH TRANSPOSITIONOF THE GREAT VESSELS. F. I. Ehrenstein, J. L. Attkeney, J. Liebman and L. H. Coffin. Ann. Thorac. Surg. 8:66-72
(July)
1969.
Twenty patients with transposition underwent Edwards’ modification of the Blalock-Hanlon procedure. Six of these had had intact ventricular septa and of these 3 died postoperatively with bilateral pulmonary hemorrhage and one with thrombosis of the right pulmonary veins. One AORTIC VALVULAR ARTRESIA AND PREMATURE survivor, with an additional large atria1 septal CLOSURE OF THE FORAMEN OVALE. C. R. defect, is doing well and the other two survivors Peterson, D. N. Bramwit, D. E. Craig and R. C. showed progressive cyanosis, culminating in death Jones. J. Thorac. Cardiov. Surg. 58:79-83 during re-operation for ASD creation in one pa(July) 1969. tient and in successful complete correction in the This is a report of the clinical and postmortem second. Fourteen of these patients had coexisting venfindings in a newborn with aortic atresia, hypotricular septal defects with 2 operative deaths. plasia of the left ventricle and closure of the The other 12 showed prolonged improvement in foramen ovale. The angiographic appearance of cyanosis and cardiac failure, although one dethis entity is similar to that of truncus arteriosus, teriorated 2 years later and died during total and the authors point out means of differentiating correction, and another, with mild persistent failbetween the two. The anomaly described in this ure also failed to survive later correction. Only paper is not presently operable, but lesser degrees of abnormality are-hence the importance of disone of these patients had had pulmonary arterial tinguishing it from truncus arteriosus.-J. G. banding and subsequently showed increasing cyaRosenkrantz. nosis. Four other patients banded themselves postoperatively, with the development of signifioutflow obstruction after the PALLIATIVETREATMENT IN TRICUSPID ATRESIA. cant left ventricular atrioseptoplasty. W. Rashkind, 1. Waldhausen, W. Miller and Others have reported similar findings and the S. Friedman. J. Thorac. Cardiov. Surg. 57:812consensus at the present time seems to be that 818 (June) 1969. Edwards’ modification of the Blalock-Hanlon proThe authors describe 8 infants with tricuspid cedure should not be used in the patient with atresia or stenosis and large a-waves in the right transposition and on intact ventricular septum. In atrium who underwent balloon atrioseptostomy the patient with transposition and ventricular and immediate operative creation of an aorticseptal defect, whether it is preferable to creation right pulmonary arterial anastomosis (7 patients) of an atria1 septal defect and pulmonary arterial or pulmonary artery banding (1 patient). Two banding remains to be seen.--l. G. Rosenkrantz. infants died after the shunt procedure, one on the first postoperative day with diffuse pulmonary VENTRICULAR SEPTAL DEFECT AND AORTIC emphysema and one on the sixth postoperative REGURGITATION. K. A. Hallidie-Smith, E. G. 1. day with intestinal obstruction and peritonitis. Olsen, C. M. Oakley, J. F. Goodwin and W. P. When, in a patient with tricuspid atresia, there Cleland. Thorax 24:257-259 (May) 1969. is evidence of increased right atria1 pressure and either increased or decreased pulmonary flow, the Twenty-seven of 29 patients with associated authors recommend immediate attack on both ventricular septal defect and aortic regurgitation interatrial obstruction (by balloon septostomy) were operated upon at the Cardiothoracic Surgical and abnormal pulmonary flow (by surgery). One Unit of the Royal Postgraduate Medical School might well argue that, since balloon septostomy in London, England. The most common cause of